The Three Essential Responsibilities of a Nurse Informaticist
As data becomes more widely used to drive healthcare improvement, so does the term “informatics,” referring to processing, storing, and retrieving data to optimize healthcare delivery and improve patient outcomes. But who are the people behind the scenes—the informaticists—who make these data processes happen? There are many types of informaticists in healthcare (e.g., nursing, lab, medical), but the nurse informaticist plays a pivotal role in identifying, defining, and sharing data, information, and knowledge in the science of nursing.
With massive amounts of data at health systems’ fingertips—and exacerbated by the urgency for even more data in response to COVID-19—a nurse informaticist’s role is vital for health systems to maximize data-driven nursing practice in pandemic management and the everyday clinical setting. Nurse informaticists’ familiarity with nursing’s frontline role in a clinical setting combined with an understanding of clinical processes and workflows enables them to maximize data and technology in daily nursing practice. More than a translator who works in silos with the IT department, a nurse informaticist bridges the gap between data and clinical nursing practice. Nurse informaticists understand the flow of data at a deep level and make modifications to support new methods that lead to safe care delivery.
The American Nurses Association defines nursing informatics as the specialty that integrates nursing science with multiple information and analytical sciences to identify, define, manage, and communicate data, information, knowledge and wisdom in nursing practice. Nurse informaticists support nurses, consumers, patients, the interprofessional healthcare team, and other stakeholders in their decision-making in all roles and settings to achieve desired outcomes. This support is accomplished through the use of information structures, processes, and technology.
The Evolution of a Nurse Informaticist
The role of a nurse informaticist has evolved since its initial function as a “clinical analyst.” As healthcare focuses more on data science-centric processes to improve patient care, such as machine learning and artificial intelligence, technology adoption and communication between clinical teams and IT resources (e.g., the EHR or an ancillary system) are paramount. Because nurse informaticists practice at the intersection of technology and clinical practice, nursing informatics is now a well-established specialty that has grown beyond designing the EHR.
Technology is not just part of healthcare; it is healthcare. Examples include point-of-care solutions (e.g., electronic physiologic monitors, electrocardiogram, glucometers, and more), patient portals, external health information exchanges, and public health reporting. As such, the nurse informaticists’ role is an integral part of healthcare delivery, encompassing system selection and implementation and training of technologies to provide safe, high-quality, patient-centric care across the continuum, no matter the delivery method.
Though perhaps not as well-known as other nursing fields, the American Nurses Credentialing Center (ANCC) recognizes nursing informatics as a specialty with board certification. Additionally, nursing informatics provides a career path in leadership, as demonstrated by the increase in Chief Nursing Informatics Officer (CNIO) positions across health systems. The CNIO serves as a bridge between nursing and information technology and partners with the Chief Medical Information Officer, who serves as a bridge between the medical community and information technology—together, the CNIO and CMIO focus on information, data, and communication.
With the shift to value-based care, nursing informaticists focus on a variety of technical areas to better support patients, nursing staff, and other healthcare providers:
- Departmental systems improvement.
- EHR implementation.
- Documentation optimization.
- Accurate data capture and process changes that support regulatory measures and other strategic initiatives.
- Care coordination.
- Population health initiatives.
Nurse Informaticists Play Pivotal Role in the Fight Against COVID-19
The nursing informatics role is expanding beyond process, implementation, and data capture in the face of COVID-19. The pandemic has resulted in new IT challenges for hospital workforce including data capture, system updates, implementation and integration of new technologies, and process changes. For example, hospital leadership faces staffing and supply chain shortages, capacity challenges, field hospital management, temporary relaxation of documentation and regulatory reporting requirements, and a focus on patient throughput; simultaneously, they must maintain compassionate, quality care. With minimal resources and waning energy, health systems engage nurse informaticists to operate safely amid shifting technology, protocols, and regulations.
Another way a nurse informaticist’s role is especially valuable during a crisis is by helping to quickly adjust workflows and scale care delivery. With the dramatic increase in telehealth visits since the onset of COVID-19, nurse informaticists have worked with physicians and other disciplines to modify existing workflows and systems to properly capture consent and then document telehealth visits. With the time-sensitive shift from in-person to telehealth visits, health systems have had to leverage a nurse informaticist’s expertise to rapidly design and test technology and workflows while simultaneously training end users before deployment.
Three Essential Responsibilities of a Nurse Informaticist
With COVID-19 driving more data sharing, health systems have access to have even more data. However, many organizations still struggle to leverage that data to drive long-term improvements. Nurse informaticists have three essential responsibilities that help the nursing workforce document and submit accurate data and leverage it to develop evidence-based procedures for optimal care delivery.
Responsibility #1: Understand and Communicate the “Why” Behind New Processes
Knowing the why behind any process and communicating it to the nursing workforce and key stakeholders is critical for accuracy and adoption. When a nurse informaticist explains the importance of documenting specific observations and measures (e.g., height, weight, and allergies), nurses understand the long-term ramifications of incorrect or missing data on a person’s health and feel more accountable for capturing the correct data. Increased understanding also builds the nurses’ confidence in the system’s data, making them more likely to rely on that data to make decisions.
For example, an EHR could require documenting a patient’s height and weight and allergies during the admission assessment before a team member can enter new orders into the system. An estimated height and weight or missing documentation of allergies has downstream impacts for determining correct medications and dosages as well as avoiding a potential adverse event. A crucial part of a nurse informaticist’s job is to educate the workforce about the reasons behind these EHR requirements and their far-reaching effects. This insight helps the care team understand how specific data play an important role throughout the care process and decision making.
Responsibility #2: Implement New Technology and Processes
Any type of new electronic implementation (e.g., an EHR or patient portal) means a change in the clinical process. The clinical team will evaluate and adapt current processes in the context of the new technology and then implement it. With greater data access, health systems can identify additional care gaps and improvement opportunities, making a nurse informaticist’s role in new process education and implementation even more critical.
New processes bring improvement opportunities, but they also bring pain points and learning curves that can discourage team members. Without proper training and implementation, new technologies can flounder, fail to gain adoption, or even lead to unsafe workarounds, resulting in compromised patient safety and team member frustration. An effective nurse informaticist guides a new process implementation from beginning to end, setting team members up for success.
For example, an ICU nurse needs to use a new module in the EHR to capture the physiological (e.g., hemodynamic) monitoring of a patient. The new module requires capturing the data directly from the monitoring device and verifying it versus manually entering it in an electronic format or historically documenting it in a paper-based flow sheet. Logging the hemodynamic monitoring electronically focuses on real-time data capture. With a manual entry process, the nurse may delay data entry until a break or at the end of his/her shift, meaning that notes (or data) wouldn’t be available until later. The problem is that waiting to capture the data (the hemodynamic monitoring information) informs how other care team members will execute their care delivery and planning. If the latest data isn’t available, providers make care decisions based on incomplete information.
This change in the process means the nurse has to electronically submit information throughout a shift instead of during a break. A nurse informaticist, understanding the complex nature of nursing and the challenges of disrupting a routine, would provide education about the new process before implementation, ensure testing completion and provide hands-on training within the EHR, and a thorough explanation of the new approach’s benefits compared to the old method.
Responsibility #3: Validating Data with the Three Vs
The nursing informaticist role is expanding to encompass greater responsibility with data and analytics. To promote a data-driven decision making in clinical practice through effective data utilization and adoption.
- Volume: Health systems have access to (what seems like) unlimited data. A nurse informaticist realizes the actual volume of data (e.g., clinical notes, admission assessments, vital signs medications, and lab results) and various data sources the organization can leverage to support data-driven decision making. The informaticist role is emerging to include data stewardship and data validation in support of an organization enterprise-wide data strategy.
- Velocity: Data sharing is critical for health systems to deliver comprehensive care based on complete patient information. This means the velocity, or the speed at which data travels, is also critical. Delayed access to data can lead to postponed decision making or decisions based on incomplete data. Part of understanding data velocity is also communicating what data will be available and when to enable decisions (e.g., near real-time versus retrospective analysis). For example, real-time clinical data supporting analysis of possible and/or actual Hospital Acquired Conditions (HAC) enables the care team to take timely actions that impact patient safety versus using that same data retrospectively to identify trends over time. For population health, both clinical data and claims data are included in care coordination and closing care gaps; however, the velocity of claims data is currently less frequent than clinical systems and EHR data.
- Variety: Validating data requires the informaticist to understand the different data sources and how they do—or do not—come together. Today’s electronic environment is comprised of discrete data, unstructured data, images, and connected device data (to name a few) that need to be validated. Nurse informaticists understand the variety of data sources and how to evaluate the data to tell a cohesive story about the patient and the population. For example, a nurse informaticist might discover that missing data sets could be a result of data not integrated into the EHR. The ability to dig deeper into data variety and then adjust processes to harmonize the data is critical to delivering care based on complete data sets.
A Nurse Informaticist: Critical to Healthcare Success Now and in the Future
With a multifaceted focus to transform data into information, nurse informaticists communicate that information to team members so they can help patients reach peak health and help health systems reach optimal performance. At a crossroads where nursing, computer, and information science meet, a nurse informaticist evaluates aggregated data to drive change, improve efficiency, cut costs, and improve the quality of patient care.
As the healthcare industry relies more on data to understand patient populations, deliver value-based care, and combat COVID-19, a health system must adopt increasingly data-friendly processes and workflows across the organization. Data can improve accuracy and guide clinical best practice, but changes also bring new challenges for team members. A nurse informaticist provides information about new workflows, guides new technology and process implementation, and assesses data quality, giving care teams the best chance of optimal care delivery. With extensive clinical background, growing analytics acumen, process and workflow intelligence, and technology savvy, a nurse informaticist is critical for health systems to leverage data to better meet every team member and patient need.
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